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Goiter refers to an abnormal enlargement of the thyroid gland that may appear as a diffuse goiter (uniform enlargement) or nodular (single or multiple nodules). Functionally, it is classified as nontoxic (normal/low hormone levels) or toxic (excess hormone production).PathophysiologyDiffuse thyroid enlargement typically results from prolonged stimulation by thyroid-stimulating hormone (TSH) or TSH-like agents, commonly seen in hypothyroidism or iodine deficiency. In contrast, in hyperthyroid...
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Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactivity of the thyroid gland. It results from autoantibodies called thyroid-stimulating immunoglobulins (TSIs), which bind to thyroid-stimulating hormone (TSH) receptors, leading to overstimulation of hormone production and a hypermetabolic state.EtiologyAlthough considered idiopathic, Graves’ disease has well-established contributing factors. There is a strong genetic component, with increased prevalence...
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Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor,...
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Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH...
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Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
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Localized subacute thyroiditis presenting as a painful hot nodule.

Lian-Xi Li1, Xing Wu, Bing Hu

  • 1Department of Endocrinology and Metabolism, Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China. lilx@sjtu.edu.cn.

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Summary

This rare case highlights subacute thyroiditis presenting as a painful, hot thyroid nodule with normal inflammatory markers. Early diagnosis and treatment with prednisone led to complete resolution.

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Area of Science:

  • Endocrinology
  • Nuclear Medicine
  • Pathology

Background:

  • Subacute thyroiditis typically presents with specific clinical features.
  • While often associated with cold nodules, hot nodules in subacute thyroiditis are exceptionally rare.

Purpose of the Study:

  • To report an unusual case of subacute thyroiditis.
  • To emphasize the importance of considering subacute thyroiditis in differential diagnoses for hot thyroid nodules.

Main Methods:

  • Case presentation of a 57-year-old woman with neck pain and fatigue.
  • Diagnostic workup included physical examination, laboratory tests (WBC, ESR, thyroid function, thyroglobulin), ultrasound, thyroid scintigraphy (99m-Tc), and fine-needle aspiration biopsy.
  • Treatment with prednisone and follow-up imaging.

Main Results:

  • The patient presented with a painful, tender, hot nodule in the left thyroid.
  • All laboratory tests, including ESR and thyroglobulin, were normal.
  • Ultrasound showed a hypoechoic mass, and scintigraphy revealed focal radiotracer uptake.
  • Fine-needle aspiration biopsy identified multinuclear giant cells.
  • Prednisone treatment resulted in nodule disappearance and symptom resolution.

Conclusions:

  • This case represents a rare instance of subacute thyroiditis presenting as a localized, painful hot nodule.
  • Normal inflammatory markers (ESR) and thyroglobulin levels do not exclude subacute thyroiditis.
  • Subacute thyroiditis should be considered in the differential diagnosis of hot thyroid nodules, even with atypical presentations.